Study On Sleep Quality Of Elderly Patients With Multimorbidity And Patient-centered Care Approaches In Primary Care

Backround: With the aggravation of the aging process of population,the sleep quality of the elderly has become an important issue of social concern.In the community,the elderly often merge with a variety of chronic diseases,including sleep disorders,which brings many challenges to primary health care services.Studies have shown that compared with the elderly patients with single chronic diseases,the sleep quality of the elderly patients with chronic diseases is poor,It affects the comprehensive control level of patients with multiple cardiovascular risk factors,and the grass-roots sleep quality management is insufficient.Especially since the outbreak of COVID-19 in 2020,the sleep management of the elderly is facing new challenges.At present,there are few researches on community general practitioners adopting patient-centered methods to carry out individualized sleep quality management.For this reason,this study investigated the sleep quality of elderly patients with chronic comorbidities in communities in two cities in Liaoning Province,and proposed a human-centered individual The strategy of integrated sleep management is expected to provide reference for general practitioners and other family doctor teams to improve the sleep health management level of elderly patients with chronic diseases and comorbidities.Objective: To understand the prevalence and influencing factors of sleep disorders in elderly patients with chronic comorbidities in the communities of Liaoning and Liaoning,and to formulate individualized sleep health management strategies for elderly patients with comorbid chronic diseases.Methods: From November 2020 to December 2020,elderly patients(≥ 60 years old)with comorbid chronic diseases were selected from two health service centers in Da’nan Community of Shenyang City(inland city)and Liudaokou Community of Dandong City(coastal city).Elderly patients with two or more chronic diseases are identified by consulting health files.Elderly patients with sleep disorders are screened using PSQI scale.Interviews are used to understand the current status of sleep health management in the community.Method and Expert Meeting Method to discuss and formulate individualized sleep health management strategies for patients with chronic diseases and comorbidities.Results: In the community,the prevalence of chronic diseases in the elderly aged 60 and above is 73.66%(386/524),and the prevalence of chronic disease comorbidities is42.75%(224/524).The status of sleep quality: According to the PSQI criteria,the prevalence of sleep disorders among elderly people aged 60 and over with chronic diseases and comorbidities in the community is 44.64%(100/224).The prevalence of combined 2,3,4,5 and more chronic diseases are 19.4%(102/524),9.5%(50/524),6.4%(34/524),7.0%(38/524),respectively.Comparing the sleep disorder group and the non-sleep disorder group of elderly patients with chronic disease and comorbidity,gender(x 2=4.042 P=0.044),cerebrovascular disease(x 2=4.625 P=0.032),coronary heart disease(x2=4.790 P=0.029)),hypertension(x2=5.380 P=0.020),diabetes(x2=3.966P=0.046),dyspepsia(x2=4.633 P=0.031),thyroid disease(x2=4.996,P=0.025),chronic pain(x2 =4.598,P=0.032),all P<0.05,the results are statistically different.The results of telephone interviews with general practitioners/family doctors show that: some(1/7)family doctors have insufficient understanding of sleep disorders in the elderly,and all general practitioners/ Families do not routinely use sleep quality scales to evaluate patients’ sleep quality in community work,and rarely provide systematic and standardized sleep hygiene education.Developed individualized sleep health management strategies for patients with chronic diseases and comorbidities,and conducted pilot applications.Conclusion: In this study,the prevalence of sleep disorders in elderly patients with chronic diseases and comorbidities was 44.64%,and the detection rate of sleep disorders in patients with chronic diseases and comorbidities was significantly higher than that of the general elderly.The majority of patients with chronic comorbidities in the community are those at high risk of cardiovascular disease.The top five chronic diseases are hypertension,coronary heart disease,chronic pain,diabetes,and indigestion.Sleep disorders in elderly patients with chronic diseases are more common,and family doctors in some communities do not have sufficient knowledge of elderly sleep disorders.The results of the intervention strategy research and its pilot application in this article suggest that we should learn from the Ariadne principle and adopt a human-centered clinical approach to help elderly patients with chronic comorbidities improve their sleep quality.In turn,it will help control cardiovascular risk factors such as hypertension and diabetes,and improve the level of care services for the whole person.